Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
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Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Tuesday, Feb. 11.
Editor’s note: Responses were lightly edited for clarity and length.
Question: What spine cases will stand out as the most cost-effective to perform within the next decade?
Michael Dorsi, MD. DISC Sports & Spine Center (Marina Del Rey, Calif.): When we think of the cost-effectiveness of treatment, we must consider both the immediate upfront price tag as well as the future costs and savings. Decompressive procedures will remain significantly less expensive than instrumented procedures, particularly as more surgeons adopt minimally invasive techniques and move their patients to the ASC. Disc arthroplasty will continue as a cost-effective alternative to fusion, both in the initial price point as well as the potential downstream savings from decreased additional surgeries for pseudoarthrosis or adjacent segment degeneration.
My greatest hope is that the next decade brings us legitimate advances in regenerative medicine procedures. Ideally we can begin to prevent or reverse the degenerative changes and prevent the need for surgery altogether.
Brian Fiani, DO. Spine Surgeon. (Birmingham, Mich.): Outpatient spine surgeries: As surgical techniques improve and anesthesia becomes safer, more spine surgeries are being performed on an outpatient basis. This approach can significantly reduce costs associated with extended hospital stays and follow-up care.
Robotic-assisted spine surgery: Although initial investments in robotic systems can be high, the precision and efficiency they offer may lead to better outcomes and fewer complications over time, making them cost-effective for certain procedures.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Spinal arthroplasty remains one of the best and most cost-effective ways to maximize patient mobility and pain control. The correct patient selection is still absolutely critical. But in terms of longevity of implants, pain control, and much, much slower progression of adjacent level problems, it is by far the better option than chasing the white rabbit of fusion. Spinal fusion will always be an important tool in many cases. The costs of the case and utilization of resources is still high. And, it should be used when it has got to be used. However, if disc replacement is right for the patient, it should be strongly considered.
Anthony Giuffrida, MD. Cantor Spine Center at the Paley Orthopedic & Spine Institute (Fort Lauderdale, Fla.): Non-surgical interventions that fix, instead of alleviate, spine problems will be the focus of cost-effective care over the next decade. Chronic lower back pain is a health issue suffered by millions, accounting for a major portion of healthcare expenditures worldwide. In the United States, it is estimated that direct costs for treatment, including diagnostics, physical therapy, medications, and surgeries, exceed $100 billion annually. This doesn’t account for the indirect costs stemming from lost productivity and disability claims. Lower back pain is the leading cause of missed work days, which significantly impacts workforce efficiency, placing a burden on employers and the economy. Traditional treatment options often focus on symptom management rather than addressing the underlying cause, which can result in recurrent episodes and escalating costs over time.
A novel treatment of multifidus stimulation represents one of these non-surgical, cost-effective and innovative solutions by targeting and treating dysfunction in the multifidus muscle, which is a critical stabilizer of the lumbar spine. It has been shown that multifidus dysfunction is commonly associated with chronic lower back pain, as this muscle plays a key role in maintaining spinal stability. Multifidus stimulation with the Reactiv8 device delivers precise electrical stimulation to the multifidus, restoring its strength and function. This targeted approach reduces the need for prolonged or repeat treatments such as invasive surgeries, repeated injections or chronic medication use, which are often expensive and carry significant risks. Clinical studies have demonstrated that the Reactiv8 therapy not only alleviates pain but also improves physical function and quality of life, with sustained benefits over time.
By addressing the root cause and promoting long-term recovery. In a study published in the Journal of Pain Research, patients receiving Reactiv8 therapy reported substantial reductions in pain and disability scores, as well as decreased reliance on other medical interventions. Employers and healthcare systems alike will benefit from this cost-effective solution, as it helps patients return to work and normal activities more quickly, thereby mitigating both direct and indirect costs of chronic lower back pain.
Mark Liker, MD, DISC Sports & Spine Center (Valencia, Calif.): Of course, the foundation of spinal surgery is and will always be the lumbar microdiscectomy. The patient is generally in severe discomfort prior to surgery, the recovery after surgery is generally quick and the effects of surgery are generally impactful to the patient and durable. Disc replacement surgery — both cervical and lumbar — is also cost-effective to the extent that the recovery time is less than fusion and the patient can return to activity and work responsibilities in a shorter period of time. Both of these surgeries are also now performed regularly in ASCs, further reducing costs.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The most cost effective surgery will be the right surgery. There are many who opined that endoscopic surgery will be more cost effective than open surgery, that decompressions will be more cost effective than fusions, or that foraminotomies may be more cost effective than artificial disc replacements. However, the question really is not about what surgery is more cost effective in a general sense. The real question is what is the right surgery for a particular patient. We all know that the wrong surgery will actually cost more in the long-term than the right surgery. Even if a decompression today costs less than a fusion, if that decompression is done in a way that makes a fusion almost inevitable in the future, that decompression actually is more costly than doing the fusion upfront. Spine surgery truly is not a one size fits all endeavor. We really do need to tailor the surgical approach to the patient’s pathology and symptoms. We have to think about both immediate and long-term outcomes. This type of approach will allow us to select the most cost effective approach for every individual patient.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Current costs of spinal surgery ranges from $15,000 to $150,000 depending on the element of complexity and involvement. A single level diskectomy completed will range between $15,000 to $35,000, while a posterolateral spinal fusion surgery will range from $80,000 to $150,000 for patients depending on geography and institution. While the additional specter of conjoined balanced billing is imposed for some patients in provider owned facilities, these costs like all others continue to be scrutinized at every step with such a large variance in cost structures. Reliable decompression surgeries which usually remedy most pain syndromes and pathologies will remain the steady and proper method of necessitated care and treatment.
